Three Rivers Kiwanis

Official Entry Form

Annual Three Rivers Kiwanis Canoe Race

Saturday, June 18, 2011, 10:00 am Start

 Sebec Village  below the dam

Paddler #1 Name/age___________________________

Paddler #1 Address ____________________________

Paddler #1 City, State, Zip_______________________

Paddler #1 Telephone __________________________

Paddler #1 Email:______________________________ 

Paddler #1 Paid __________  

Paddler #2 Name/age___________________________

Paddler #2 Address ____________________________

Paddler #2 City, State, Zip_______________________

Paddler #2 Email:______________________________

Paddler #2 Telephone ___________________________

Paddler #2 Paid __________                                          

Entry fee $15.00, includes a tee shirt, registration at 9:00 am 

Free musical entertainment; food concessions available at reasonable prices

Release:

I/We (print)___________________ AND ____________________  hereby remise, release, and forever discharge the above sponsors, Three Rivers Kiwanis, Milo Fire Department, Towns of Milo and Sebec, of and from any and all manner of actions, causes of action, suits, proceedings, debts, dues, contracts, judgments, damages, claims and demands whatsoever in law or equity, which against said sponsors I ever had, now have, or which my heirs executors or administrators hereafter can, shall, or my have, for or by any reason of my participation in the Sebec River Race to be held June 20, 2009. I further acknowledge that no representations as to the conditions, nature, or hazards of the Sebec River Race Course has been made to me by the sponsor, and I assume all risks and responsibilities for injury to myself and others and any property damage that may result from my participation in said event. I know whitewater racing is a hazardous sport.

Applicant _______________Age ___   

Parent/Guardian ____________________ Date:__________

Applicant _______________Age ___   

Parent/Guardian ____________________ Date:__________

Contact person: Bobby Ellison, Three Rivers Kiwanis Club of Milo

Telephone: 943-2317, 209 North Road, Medford, Maine 04463